Kathy L. Chapman

Timing of palatal surgery and speech outcome.

Objective: To examine the impact of age and lexical status at the time of primary palatal surgery on speech outcome of preschoolers with cleft palate. Participants: Forty children (33 to 42 months) with nonsyndromic cleft palate participated in the study. Twenty children (Group 1) were less lexically advanced and younger (mean age  =  11 months) and 20 children (Group 2) were more lexically advanced and older (mean age  =  15 months) when palatal surgery was performed. Main Outcome Measures: Samples of the childrens spontaneous speech were compared on 11 speech production measures (e.g., size of consonant inventory, total consonants correct, % correct for manner of articulation categories, compensatory articulation usage, etc.). Next, listeners rated a 30-second sample of each childs connected speech for articulation proficiency and hypernasality, separately, using direct magnitude estimation (DME). Results: Group differences were noted for 4 of the 11 speech production measures. Children in Group 1 exhibited larger consonant inventories (and true consonant inventories) and more accurate production of nasals and liquids compared to children in Group 2. On the DME task, significant group differences were found for ratings of articulation proficiency and hypernasality. Children in Group 1 exhibited better articulation and less hypernasality than children in Group 2. Conclusions: The findings suggested that children who were less lexically advanced and younger at the time of palatal surgery exhibited better articulation and resonance outcomes at 3 years of age.

The relationship between early speech and later speech and language performance for children with cleft lip and palate

This study examined the relationship between speech measures at presurgery/9 months and postsurgery/13 months and speech and language performance at 21 months for children with cleft lip and palate and their noncleft peers. Comparisons were also made between the speech and lexical development of children with cleft lip and palate and noncleft children at 21 months of age. The participants included 30 children; 15 with cleft lip and palate and 15 noncleft children. Results revealed differences between the groups for several measures of speech and lexical development at 21 months. For the children with cleft palate, correlational analyses suggested that true stop production, both immediately before and after palatal surgery, was positively correlated with a majority of the speech production measures at 21 months. At postsurgery/13 months, true stop production was related to later vocabulary development, and size of true consonant inventory was related to all measure of speech production and one measure of lexical development at 21 months. For the noncleft group, true canonical babbling ratio at 13 months was the only measure that was significantly correlated with any of the speech and/or language measures at 21 months. The impact of clefting on prelinguistic and later speech and language skills is discussed.

The Communicative Functions of Lexical Usage by Language Impaired Children.

This study examines the communicative functions served by the lexical usage of normal and language impaired children whose speech was limited to single-word utterances. The two groups were similar in the frequency with which they produced utterances serving most of the functions. However, naming was more frequent in the normal childrens speech, while answering was more frequent in the speech of the language impaired children. The two groups were indistinguishable in terms of the number of different lexical items they used in the service of each of the communicative functions.

Reliability of listener transcriptions of compensatory articulations.

OBJECTIVE This study examined the ability of speech-language pathologists to transcribe compensatory articulation errors. DESIGN Speech-language pathologists phonetically transcribed audiorecordings of 130 monosyllabic words, 70 of which contained compensatory articulations. PARTICIPANTS The participants for this study were two groups of 10 speech-language pathologists. Group I included speech-language pathologists who were experienced in evaluating children with cleft palate, and group II speech-language pathologists were not. RESULTS Marked variability was evident across listeners, with percentages of agreement ranging from 19 to 71 (mean agreement = 41%). The experienced listeners performed significantly better on the transcription task than the inexperienced listeners, but poor interjudge agreement was evident across both groups. CONCLUSIONS The results of this study suggest that speech-language pathologists may differ in their understanding of the auditory perceptual characteristics of compensatory articulations. The results underscore the need for increased training and standardization of transcription procedures.

Conversational skills of children with cleft lip and palate: A replication and extension

Objective To replicate and to extend a previous study examining the conversational skills of children with cleft lip and palate. Participants Thirty-four children (33 to 44 months) participated: 17 children with cleft lip and palate and 17 noncleft children. Methods The children were observed during an interaction with caregivers in their homes. Samples of caregiver-child interactions were coded as assertive or responsive, for type of conversational act, and for discourse level categories. Profiles of conversational activity were determined for each child based on the coding. Correlations were performed to examine the relationship between assertiveness and speech variables (articulation and resonance) for the children with cleft lip and palate. Results Group comparisons revealed that the children with cleft lip and palate produced fewer assertive utterances, were less likely to respond adequately to comments by caregivers, and produced more topic maintaining and fewer topic extending utterances than did their noncleft peers during conversational interactions. Examination of individual child data indicated that 35% of the children with cleft lip and palate exhibited conversational profiles characterized by either low assertiveness or low responsiveness. Finally, a significant positive correlation was noted between conversational assertiveness and speech production skills. Conclusion These findings suggested that the children with cleft lip and palate were less conversationally assertive than their noncleft peers. Further, there appeared to be a relationship between speech production skills and conversational skills, suggesting that poor speech may be impacting language performance for these children.

The Relationship Between Early Reading Skills and Speech and Language Performance in Young Children With Cleft Lip and Palate

Objective To examine the early reading skills of young children with cleft lip and palate and to examine the relationship between early reading skills and speech and language performance. Participants A total of 56 children participated in the study: 28 children with cleft lip and palate and 28 noncleft children matched for age (mean age, 5 years 7 months), gender, and months of formal schooling. Main Outcome Measures The two groups of children were compared (t tests) on the Test of Early Reading-3. Pearson product moment correlations were performed to examine separately the relationship between early reading skills speech production abilities and between early reading skills and receptive and expressive language abilities for the two groups. Results Statistically significant group differences were noted on the Test of Early Reading-3. The mean score of 99 obtained by the group of children with cleft lip and palate was within normal limits compared with the norms for the Test of Early Reading-3; however, 14% of the children with cleft lip and palate scored outside the normal range on the Test of Early Reading-3. Statistically significant correlations were obtained between early reading skills and speech production abilities and between early reading skills and language abilities. Conclusions Children with cleft lip and palate differed from noncleft peers in speech and early reading skills. Children with the most severe speech problems were the children with the poorest performance on the Test of Early Reading-3. Management of children with cleft lip and palate should include early identification of and intervention for delays in speech, language, and reading.

Is presurgery and early postsurgery performance related to speech and language outcomes at 3 years of age for children with cleft palate

This study examined the relationship between presurgery speech measures and speech and language performance at 39 months as well as the relationship between early postsurgery speech measures and speech and language performance at 39 months of age. Fifteen children with cleft lip and palate participated in the study. Spontaneous speech samples were obtained in the childrens homes at presurgery/9 months, postsurgery/13 months and again at 39 months of age. Correlational analyses revealed a lack of association between speech measures presurgery and early postsurgery and speech outcome measures at 39 months. Significant negative correlations were noted for true canonical babbling ratio presurgery and mean length of utterance (MLU) at 39 months, as well as for size of true consonant inventory presurgery, and both language outcome measures at 39 months (MLU and number of different words). Significant positive correlations were noted for percentage of true stops produced postsurgery and both language measures at 39 months. Variables that may have influenced speech and language development from presurgery to 39 months are discussed.

Speech-language characteristics of children with neurofibromatosis type 1

Delays in speech and articulation development have been found in school‐aged children and adolescents with neurofibromatosis type 1 (NF1). This report examines speech and language skills of preschool children with NF1. Nineteen 3‐ to 5‐year‐old children diagnosed with NF1 were assessed using measures of articulation (GFTA‐2), and receptive and expressive language (CELF‐P2). Significant differences were observed between mean scores obtained by the group of children with NF1 compared to the validated controls from the speech and language instruments (P ≤ 0.009). Sixty‐eight percent of the children exhibited delays in speech and/or language. Thirty‐two percent demonstrated delays in articulation, 37% percent demonstrated delays in receptive language, and 37% exhibited delays in expressive language. Sixteen percent of the children exhibited a voice disorder and 42% were judged to have a resonance problem. No significant differences were observed on any of the measures of speech and language for children with non‐familial versus familial NF1. Results of this study support the need for early assessment of speech and language problems for children diagnosed with NF1 and implementation of appropriate timely intervention as needed.

The Americleft Speech Project: A Training and Reliability Study.

Objective To describe the results of two reliability studies and to assess the effect of training on interrater reliability scores. Design The first study (1) examined interrater and intrarater reliability scores (weighted and unweighted kappas) and (2) compared interrater reliability scores before and after training on the use of the Cleft Audit Protocol for Speech–Augmented (CAPS-A) with British English-speaking children. The second study examined interrater and intrarater reliability on a modified version of the CAPS-A (CAPS-A Americleft Modification) with American and Canadian English-speaking children. Finally, comparisons were made between the interrater and intrarater reliability scores obtained for Study 1 and Study 2. Participants The participants were speech-language pathologists from the Americleft Speech Project. Results In Study 1, interrater reliability scores improved for 6 of the 13 parameters following training on the CAPS-A protocol. Comparison of the reliability results for the two studies indicated lower scores for Study 2 compared with Study 1. However, this appeared to be an artifact of the kappa statistic that occurred due to insufficient variability in the reliability samples for Study 2. When percent agreement scores were also calculated, the ratings appeared similar across Study 1 and Study 2. Conclusion The findings of this study suggested that improvements in interrater reliability could be obtained following a program of systematic training. However, improvements were not uniform across all parameters. Acceptable levels of reliability were achieved for those parameters most important for evaluation of velopharyngeal function.

Cognitive and language issues associated with cleft lip and palate

Language and cognitive performance of children with cleft palate with/without cleft lip (CP ± L) have received relatively little attention in the literature to date. The lack of attention directed toward these areas is probably attributed to two factors. First, the speech characteristics associated with velopharyngeal inadequacy are undoubtedly the most salient problems encountered by clinicians treating these children and thus have taken priority in research for many years. Second, early findings suggesting little difference between these children and their typically developing peers in language and cognition simply discouraged additional study. More recent investigations, however, have expanded the scope of study to include toddlers and adults and utilized alternative methodologies to study this population. In this article, we will summarize the literature and explore recent findings associated with language and cognition in children with CP ± L. In addition, we will also examine performance of children with velocardiofacial syndrome-a common syndrome associated with CP ± L.